ALARMPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date g 5 Job Address 3 33 /4.e. S I Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant AlatO /-iA OAS CU 11 I E,n1 l026 Master Permit # 1 1,( 2 S ,�
Owner's Address 3 3 3 id. C , 9%2- S Phone 3 7 O D S' f
Contracting Co. 3E-Cc 9 � k ��' ( 1) G_ Address //So N • E 57
Qualifier RD N 41M 5 SS# �- / Phone30 S ?9 3 776,6
State # e6" /d V Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): g: UILDING ELECTRICAL PLUMBING , MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION t P'— STS LL, 01 `�' -(/2 4112-1A
1 ay- -'-
Square Ft. Estimated Cost (value) c? ?
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOU!*
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
•
e of owner
d/or C
•dent
ERIC Ni. HERSH
Notary Public, State of Florida
My Comm . Expires 6 t ' 2002
•
igna
4 �
as to Own and/or Condo President
My Commissio xpires:
FEES: PERMIT ` - 4>RADON
APPROVED:
Zoning
Mechanical
Building Electrical
av
Si a r tune of Con or or Owner -B
Notary as to Con .. tor or Owner - Builder • ate
My Commission Expi{esp
Luz Albaran
f*f Imo\
,
MY COMMISSION # CC703192 EXPIRES
December 14 2001
BONDED THRU TROY FAIN INSURANCE, IN-.
C.C.F. / - S u NOTARY BOND
TOTAL DUE 57
ate
Plumbing Structural Engineer